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Month: April 2014

In 1978, Gabe Mirkin, MD coined the term RICE (Rest, Ice, Compression, Elevation). Health care practitioners and laypersons alike are quick to recognize RICE as the ‘gold standard’ treatment for acute injury. All of my patients know that in Chinese Medicine we seldom recommend Ice for any injury. Now the very same physician who coined the term RICE, Dr. Gabe Mirkin, is admitting that there is a lack of evidence to support the therapeutic use of Ice.

Dr. Mirkin describes how ice delays healing in his 3/2014 Article, Why Ice Delays Recovery. “Inflammatory cells rush to injured tissue to start the healing process. The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.” He goes on to say that, “anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by: cortisone-type drugs, almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen, immune suppressants that are often used to treat arthritis, cancer or psoriasis, applying cold packs or ice, and anything else that blocks the immune response to injury.”

Why is Ice therapy recommended so often if there is little evidence that it works? Well old habits die hard people, physicians, therapists, and laypersons alike are used to the RICE protocol, and so they continue to use it. The science supports the 3,000 year old Chinese theory that blood flow is the key to health and injury healing. Activities that increase blood flow such as acupuncture, stretching, and exercise improve tissue healing and repair, speeding up healing. Things that that limit blood flow, such steroid and non-steroid anti-inflammatory medications, ice, and compression impair or slow the healing process.

Even the National Athletic Trainer’s Association August 2013 position statement on the management of ankle sprains states that there is “limited” clinical evidence for ice therapy. However, they found stronger evidence that functional rehabilitation, proprioception, and balance exercises improve healing.

So, yes, it seems like “everybody” other than your Acupuncturist recommends ice for injuries. Now you know that “everybody” might not have read the research.

It is obvious and amazing at the same time. Obvious because we all know that exercise is “good for us”. Amazing because prescription drugs are often the first thing prescribed for most of these conditions, and not exercise. The kicker is that not only does the exercise work as well if not better, the potential “side effects” of exercise are pretty much all good ones, more energy, less stress, improved physical appearance, etc. Whereas, most prescription medications have many possible negative side effects. I thought this was a great study when it came out in Oct, 2013 and below is a copy of the Health Report I put out in my clinic about it.

Exercise is as effective as medications for preventing diabetes and repeat heart attacks, and it is potentially better than medication for averting additional strokes, according to an analysis published in 2013. The large-scale investigation found doctors had a better chance of preventing death in patients recovering from a heart attack or stroke by prescribing light fitness instead of pills. It is the first time scientists have compared the benefits of exercise with heart medication such as statins and beta blockers. Examining data on 340,000 patients who had been diagnosed with heart disease, chronic heart failure, a stroke or diabetes, the findings published in the British Medical Journal have been touted as revolutionary.

Researchers analyzed previous studies and found no marked change between the outcome of exercise and drugs for people who have diabetes or heart disease. For stroke victims, the research swung overwhelmingly in favor of exercise, showing it was far more likely to prevent death than drugs. The study leader Huseyin Naci, of LSE Health and Harvard Medical School, said more people are consuming prescription drugs but far fewer are exercising. “Exercise is a potent strategy to save and extend life in coronary heart disease and other conditions,” said Mr. Naci, “We think exercise can be considered or should be considered as a viable alternative or in combination with drug therapy.”

The results showed that in three of the four conditions studied, exercise was as effective as, or possibly more effective than, drug treatments. This wasn’t the case for heart failure, a progressive weakening of the heart’s ability to pump blood to the rest of body. Exercise has also been shown to be helpful in the short term in a number of other conditions, including depression, cognition, blood pressure and cancer treatment. Mr. Naci and his colleagues plan to study some of these other diseases in future work. He cautioned that patients with existing health conditions should talk to their doctor before stopping medication.
Sources: New York Times online, Wall Street Journal Online, and CDC.gov http://www.bmj.com/content/347/bmj.f5577 – BMJ study.

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